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Health care is made up of thousands of intertwined processes that result in an exceedingly intricate system. But, if we focus our efforts on the processes of care one at a time, we can ultimately drive sustained clinical improvement. Teams always acknowledge that there are opportunities throughout their health care systems to improve processes and eliminate waste, but with such a large, intricate system filled with so many interwoven processes, it’s challenging to decide on the starting point. What providers and their teams need is guidance to direct their efforts to where they will have the biggest impact on patient outcomes.
It has never been more important for health care providers and their teams to focus on Quality Improvement. Aside from the obvious top-ranking desire to provide the best care possible to patients, the payment model is undergoing a long overdue shift to focus more on the quality of health care being delivered. In order to maintain the highest reimbursement rates possible, providers will need to demonstrate that they are providing quality care to their patients. Failure to achieve quality health care delivery will result in reduced reimbursement rates.
On April 15, 2015, the "doc fix bill" or MACRA (the Medicare Access & CHIP Reauthorization Act) repealed the flawed Sustainable Growth Rate (SGR), used to determine physician reimbursement, and replaced it with a new pay-for-performance program. This is the first time in the history of the Medicare program that Health & Human Services has set explicit goals for alternative payment models and value-based payments.
Medicare set (and exceeded) a 2016 goal of tying 30 percent of payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs), advanced primary care medical homes or bundled payment arrangements. By the end of 2018, at least 50 percent of payments will be tied to these models.
One of these new value-based payment programs is MIPS or the Merit-based Incentive Payment System, which relies heavily on performance measures. Historically, CMS has taken data from two years prior to tabulate penalties. Information on where providers stand with what were formerly known as their Meaningful Use, PQRS and Value-based Modifier metrics from this year will determine provider Medicare Part B reimbursement rates two years later.
Early Preparation for Reimbursement Changes Will Pay Off
This is where M-CEITA can help. As Michigan’s federally designated Regional Extension Center (REC), we work with Michigan providers to accelerate the selection, adoption, and meaningful use of health information technology to improve the quality and efficiency of care delivered in our state. M-CEITA is also committed to the Million Hearts® Initiative. Through our EHR adoption services, our staff works with providers to meet the rigorous demands of the clinical quality measures related to hypertension and diabetes. You can learn more about this at our Health IT website: HITeLearningCenter.org